Risk of ischemic stroke after third, fourth, and sixth cranial nerve palsies in type 2 diabetes

• Published in: Journal of diabetes 2019-05, Vol.11 (5), p.379-385
• Main Authors: Park, Sang Jun, Yang, Hee Kyung, Byun, Seong Jun, Park, Kyu Hyung, Hwang, Jeong‐Min
• Format: Article
• Language: English
• Subjects: 2型糖尿病; Adult; Aged; Aged, 80 and over; Brain Ischemia - etiology; Brain Ischemia - pathology; Cohort Studies; Comorbidity; Cranial Nerve Diseases - complications; Cranial Nerve Diseases - epidemiology; Diabetes; Diabetes Mellitus, Type 2 - physiopathology; Diuretics; Female; Follow-Up Studies; fourth nerve palsy; Health risk assessment; Humans; Incidence; Ischemia; ischemic stroke; Male; Middle Aged; Neurological disorders; Oculomotor Nerve Diseases - complications; Oculomotor Nerve Diseases - epidemiology; Prognosis; Republic of Korea - epidemiology; Risk Factors; sixth nerve palsy; Stroke; Stroke - etiology; Stroke - pathology; third nerve palsy; type 2 diabetes; Young Adult; 第三颅神经麻痹; 第六颅神经麻痹; 第四颅神经麻痹; 缺血性卒中
• ISSN: 1753-0393; 1753-0407
• DOI: 10.1111/1753-0407.12859

Background The aim of this study was to define the risk of ischemic stroke among newly diagnosed type 2 diabetes (T2D) patients who developed ocular motor cranial nerve (CN) palsies. Methods From the National Health Insurance Service – National Sample Cohort database (2002‐2013) of a random sample of 1 025 340 Koreans, patients with newly diagnosed T2D aged ≥20 years were included in the study. The incidence of ocular motor CN palsies was identified using diagnostic codes for third, fourth, and sixth CN palsies. To determine the effect of incident ocular motor CN palsy on subsequent ischemic stroke, covariate Cox regression was used (Model 1 included only ocular motor CN palsy as a time‐varying covariate; Model 2 included ocular motor CN palsy and demographic information; Model 3 included all variables in Model 2 as well as comorbidity, concomitant medication, and the Charlson comorbidity index score). Results Of 45 820 T2D patients, 75 developed ocular motor CN palsy and 1411 had ischemic stroke. Four patients experienced ischemic stroke after the development of ocular motor CN palsy. Incident ocular motor CN palsy was associated with the subsequent risk of ischemic stroke in Models 1, 2 and 3 (hazard ratios [95% confidence intervals] 3.74 [1.40‐9.98], 3.33 [1.25‐8.89], and 2.96 [1.11‐7.92], respectively). Male sex, older age, and lower income were associated with an increased risk of ischemic stroke. Among confounders, hypertension, atrial fibrillation, and congestive heart failure were associated with the risk of ischemic stroke. Conclusions Physicians should pay more attention to manageable risk factors of ischemic stroke when diabetic patients suffer from ocular motor CN palsies. 摘要 背景 这项研究的目的是在曾经发生过眼部运动性颅神经(cranial nerve，CN)麻痹的新诊断2型糖尿病患者中，调查缺血性卒中的风险。 方法 随机样本中有1025340名韩国人，来自于全国健康保险服务‐国家样本队列数据库(2002‐2013)，将其中年龄≥ 20岁的新诊断2型糖尿病患者纳入了本研究。使用第三、第四与第六CN麻痹这3个诊断代码，确定眼部运动性CN麻痹的发病率。使用协变量Cox回归分析，确定眼部运动性CN麻痹对随后缺血性卒中发生率的影响(模型1只将眼部运动性CN麻痹作为时变协变量；模型2纳入了眼部运动性CN麻痹与人口统计学信息；模型3纳入了模型2中所有的变量，除此之外还有合并症、合并用药以及Charlson合并症指数评分)。 结果 在45820名2型糖尿病患者中，有75名发生了眼部运动性CN麻痹，1411名发生了缺血性卒中。有4名患者在发生眼部运动性CN麻痹后出现了缺血性卒中。在模型1、2与3中发生眼部运动性CN麻痹与随后的缺血性卒中风险相关(危险比[95%置信区间]分别为3.74[1.40‐9.98]、3.33[1.25‐8.89]、2.96[1.11‐7.92])。男性性别、老龄以及低收入都与缺血性卒中风险增加有关。在混杂因素中，高血压、房颤以及充血性心力衰竭与缺血性卒中风险相关。 结论 糖尿病患者发生眼部运动性CN麻痹之后，医生应更加重视缺血性卒中的可控危险因素。 Highlights A nationwide cohort study was conducted on newly diagnosed type 2 diabetes (T2D) patients to evaluate the risk of ischemic stroke in those who developed isolated ocular